Energy dispersive x-ray spectroscopy evaluation of demineralized human enamel after titanium tetrafluoride application.

OBJECTIVE: Evaluate the presence of a titanium dioxide layer after application of titanium tetrafluoride on human permanent tooth enamel. STUDY DESIGN: The sample consisted of unerupted third molars. After the removal of the roots, each tooth was mesiodistally divided into 2 fragments, one reserved for the experimental group and the other for the control group. Before the treatments the fragments were artificially demineralized. The experimental group (n=5) received an application of 4% titanium tetrafluoride, for one minute and the control group (n=5) did not receive any treatment. The samples were sputter-coated with a 20-30nm gold layer as the energy dispersive x-ray spectrometer analysis was carried out in a scanning electron microscope and the results were descriptively analyzed. RESULTS: The titanium dioxide layer was present on all experimental samples with a titanium peak varying between 6.82 and 26.37%. This layer was not found in the control group. Fluoride and calcium fluoride precipitates were present in the samples treated with titanium tetrafluoride. CONCLUSION: Titanium dioxide layer was formed after one titanium tetrafluoride application, but it was not uniform. Further studies should be carried out so that both the morphology and thickness of such layers can be better understood.

Adipose tissue-derived factors as potential biomarkers in cachectic cancer patients.

Cachexia, a paraneoplastic syndrome markedly associated with worsened prognosis in cancer patients, provokes profound wasting of both lean and adipose mass in an association with a state of metabolic "chaos". The white adipose tissue responds to cachexia with marked local inflammation and may be thus a relevant contributor to systemic inflammation. To address this hypothesis we examined the correlation between tissue expression of adipokines and plasma concentration in cachectic and stable weight patients with or without cancer. Adiponectin and liver-derived CRP concentration were significantly higher in the cachectic groups when compared with stable weight patients (P<0.01). The concentration of plasma IL-6 was higher (11.4-fold) in the cancer cachectic group when compared with weight-stable controls, and presented a significant correlation with the presence of cancer (P<0.001). A marked increase (5-fold) in IL-6 as a result of the interaction between the presence of cachexia and the presence of tumour was observed in the subcutaneous tissue of the patients, yet not in the visceral depot. Plasma adiponectin levels were higher in cachectic cancer patients, compared with stable weight cancer patients individually matched by age, sex, and BMI, and the subcutaneous depot was found to be the main contributing tissue, rather than the visceral pad. Based on the results we concluded that the subcutaneous adipose tissue is associated with plasma changes that may function as markers of cachexia.

Update of the classification of midpalatal suture behaviour after surgically assisted rapid maxillary expansion using computed tomography.

The aim of this study was to update the midpalatal suture classification after surgically assisted rapid maxillary expansion (SARME) using computed tomography (CT). Thirty-five patients with a transverse maxillary deficiency and unilateral or bilateral posterior crossbite underwent SARME with osteotomy of the pterygoid apophysis of the sphenoid. CT was performed before installation of the Hyrax expander appliance and after the final activation. Opening of the midpalatal suture was classified into three types: type I, total midpalatal suture opening from anterior nasal spine (ANS) to posterior nasal spine (PNS); type II, partial midpalatal suture opening from ANS to the transverse palatine suture, with partial or non-existent opening of the midpalatal suture posterior to the transverse palatine suture; type III, complete maxillary opening from ANS, but not of PNS, because a paramedian fracture completed the opening of the hard palate. Type I was observed in 42.8% of the patients, type II in 40%, and type III in 17.2%. Opening of the transverse palatine suture was found in all midpalatal suture opening patterns and was more frequent in type III, followed by type II and type I. CT was used to update the classification of midpalatal suture patterns, with the inclusion of type III: total opening of the hard palate due partly to opening of the midpalatal suture and partly to a paramedian fracture.

Adipose tissue inflammation and cancer cachexia: possible role of nuclear transcription factors.

Cancer cachexia is a multifaceted syndrome whose aetiology is extremely complex and is directly related to poor patient prognosis and survival. Changes in lipid metabolism in cancer cachexia result in marked reduction of total fat mass, increased lipolysis, total oxidation of fatty acids, hyperlipidaemia, hypertriglyceridaemia, and hypercholesterolaemia. These changes are believed to be induced by inflammatory mediators, such as tumour necrosis factor-α (TNF-α) and other factors. Attention has recently been drawn to the current theory that cachexia is a chronic inflammatory state, mainly caused by the host's reaction to the tumour. Changes in expression of numerous inflammatory mediators, notably in white adipose tissue (WAT), may trigger several changes in WAT homeostasis. The inhibition of adipocyte differentiation by PPARγ is paralleled by the appearance of smaller adipocytes, which may partially account for the inhibitory effect of PPARγ on inflammatory gene expression. Furthermore, inflammatory modulation and/or inhibition seems to be dependent on the IKK/NF-κB pathway, suggesting that a possible interaction between NF-κB and PPARγ is required to modulate WAT inflammation induced by cancer cachexia. In this article, current literature on the possible mechanisms of NF-κB and PPARγ regulation of WAT cells during cancer cachexia are discussed. This review aims to assess the role of a possible interaction between NF-κB and PPARγ in the setting of cancer cachexia as well as its significant role as a potential modulator of chronic inflammation that could be explored therapeutically.

Effects of depot growth hormone replacement on thyroid function and volume in adults with congenital isolated growth hormone deficiency.

BACKGROUND: Conflicting data exist on the effects of GH replacement therapy (GHRT) on thyroid function and thyroid volume (TV) in GH-deficient (GHD) patients. AIM: The aim of this study was to assess the effects of GHRT on thyroid function and TV in adults with congenital lifetime isolated GHD (IGHD). SUBJECTS AND METHODS: We studied 20 GH-naïve adults with IGHD due to a homozygous mutation of the GHRH-receptor gene at baseline, after 6-month depot- GH replacement therapy (pGH), and 6-month washout (6mo). Total T(3), free T(4) (FT(4)), reverse T(3) (rT(3)), TSH, IGF-I, SHBG, and TV were measured; body surface area-corrected TV (CTV) was calculated. RESULTS: IGF-I and T(3) increased pGH. T(3) levels remained elevated at 6mo. GHRT did not significantly change FT(4), rT(3), TSH, and SHBG. TV and CTV increased pGH and remained elevated at 6mo. CONCLUSIONS: GHRT in IGHD adults caused an increase in serum T(3) levels and TV, suggesting an important role of the GH-IGF-I axis in thyroid function.

Prognostic factors in neoadjuvant treatment followed by surgery in stage IIIA-N2 non-small cell lung cancer: a multi-institutional study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society).

PURPOSE: To evaluate the prognostic factors associated with survival in patients treated with neoadjuvant treatment [chemoradiotherapy (CRT) or chemotherapy] followed by surgery (CRTS) in patients with stage IIIA-N2 non-small cell lung cancer (NSCLC). METHODS: A retrospective study was conducted of 118 patients diagnosed with stage T1-T3N2M0 NSCLC and treated with CRTS at 14 hospitals in Spain between January 2005 and December 2014. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was performed. RESULTS: Surgery consisted of lobectomy (74.5% of cases), pneumectomy (17.8%), or bilobectomy (7.6%). Neoadjuvant treatment was CRT in 62 patients (52.5%) and chemotherapy alone in 56 patients (47.5%). Median follow-up was 42.5 months (5-128 months). 5-year OS and PFS were 51.1% and 49.4%, respectively. The following variables were independently associated with worse OS and PFS: pneumonectomy (vs. lobectomy); advanced pathologic T stage (pT3 vs. pT0-pT2); and presence of persistent N2 disease (vs. ypN0-1) in the surgical specimen. CONCLUSIONS: In this sample of patients with stage IIIA-N2 NSCLC treated with CRTS, 5-year survival (both OS and PFS) was approximately 50%. After CRTS, the patients with the best prognosis were those whose primary tumour and/or mediastinal nodal metastases were downstaged after induction therapy and those who underwent lobectomy. These findings provide further support for neoadjuvant therapy followed by surgery in selected patients.

Neoadjuvant treatment followed by surgery versus definitive chemoradiation in stage IIIA-N2 non-small-cell lung cancer: A multi-institutional study by the oncologic group for the study of lung cancer (Spanish Radiation Oncology Society).

OBJECTIVES: The role of surgery in stage IIIA-N2 non-small cell lung cancer (NSCLC) is an actively debated in oncology. To evaluate the value of surgery in this patient population, we conducted a multi-institutional retrospective study comparing neoadjuvant chemoradiotherapy or chemotherapy plus surgery (CRTS) to definitive chemoradiotherapy (dCRT). MATERIAL AND METHODS: A total of 247 patients with potentially resectable stage T1-T3N2M0 NSCLC treated with either CRTS or dCRT between January 2005 and December 2014 at 15 hospitals in Spain were identified. A centralized review was performed to ensure resectability. A propensity score matched analysis was carried out to balance patient and tumor characteristics (n = 78 per group). RESULTS: Of the 247 patients, 118 were treated with CRTS and 129 with dCRT. In the CRTS group, 62 patients (52.5%) received neoadjuvant CRT and 56 (47.4%) neoadjuvant chemotherapy. Surgery consisted of either lobectomy (97 patients; 82.2%) or pneumonectomy (21 patients; 17.8%). In the matched samples, median overall survival (OS; 56 vs 29 months, log-rank p = .002) and progression-free survival (PFS; 46 vs 15 months, log-rank p < 0.001) were significantly higher in the CRTS group. This survival advantage for CRTS was maintained in the subset comparison between the lobectomy subgroup versus dCRT (OS: 57 vs 29 months, p < 0.001; PFS: 46 vs 15 months, p < 0.001), but not in the comparison between the pneumonectomy subgroup and dCRT. CONCLUSION: The findings reported here indicate that neoadjuvant chemotherapy or chemoradiotherapy followed by surgery (preferably lobectomy) yields better OS and PFS than definitive chemoradiotherapy in patients with resectable stage IIIA-N2 NSCLC.

Purification of a beta-galactosidase from cotyledons of Hymenaea courbaril L. (Leguminosae). Enzyme properties and biological function.

Beta-galactosidases are enzymes that can be found in most living beings and in the plant kingdom its activity and genes have been detected in several tissues such as ripening fruits, developing leaves and flowers and storage tissues such as cotyledons. In plants, their activities are usually associated with the secondary metabolism or with oligosaccharide or polysaccharide degradation. Polysaccharide specific beta-galactosidases include beta-galactanases, which attack pectic polymers and beta-galactosidases that attack xyloglucans (XG). In the present work we purified an XG-specific beta-galactosidase (named hcbetagal) from cotyledons of developing seedlings of Hymenaea courbaril, a legume tree from the Neotropical region of the world. The enzyme has a molecular weight of 52-62 kDa and was shown to attack specifically xyloglucan oligosaccharides (XGOs) but not the polymer. It has a pH optimum between 3 and 4 and at this pH range the enzyme increases activity linearly up to 50 degrees C. Kinetic studies showed that hcbetagal is inhibited competitively by free galactose (K(i) = 3.7). The biochemical properties of hcbetagal as a whole suggest that it is involved in storage xyloglucan mobilisation during seedling development. Its high specificity towards XGOs, the low pH optimum and the fact that it is inhibited by its product (galactose) suggest that hcbetagal might be one of the biochemical control points in xyloglucan catabolism in vivo. A possible relationship with functional stability of the wall during cell death as cotyledons undergo senescence is discussed.

Long-term survival (>25 years) of deceased donor kidney transplant recipients: a single-center experience.

INTRODUCTION: The aim of this preliminary work is to analyze the clinical features of 52 patients with a functional transplanted kidney for >25 years (all first transplant and all deceased donor recipients) and to compare with a similar though more complete study from Hôpital Necker-Paris 2012. METHODS: The mean graft survival at 25 years is 12.7% and at 30 years is 10%. The actual mean serum creatinine concentration is 1.3 mg/L. We analyzed recipient age (mean, 35.9 years) and gender (29 men and 23 women). Donor age was 26.7 ± 10.3 years. Seven patients (13.4%) were transplanted with 1 HLA mismatch, 42.3% with 2 mismatches, and 44.2% with 3 mismatches. Mean cold ischemia time was 15.45 ± 7.7 hours. Of the recipients, 76% had immediate graft function; 38% experienced 1 acute rejection episode and 4 patients had 2 rejection crises. The initial immunosuppressive regimen was azathioprine (AZA) + prednisolone (Pred) in 14 patients, cyclosporin (CSA) + Pred in 13 patients, and CSA + AZA + Pred in 25 patients. Of these patients, 19% maintained their initial regimen, and 54% (28 patients) were very stable on a mixed CSA regimen for >25 years. RESULTS: We present the major complications (diabetes, neoplasia, and hepatitis C virus positivity). CONCLUSION: Our results in deceased donor kidney recipients for >25 years are similar to the mixed population (deceased donors and living donors) presented by the Necker group, although 54% of our patients remain on CSA immunosuppression, contradicting the idea that its use is not compatible with good long-term kidney function in transplant recipients.

Low-temperature phase transformation studies in the stearic acid: C form.

This paper reports the temperature-dependent measurements in the C form of stearic acid. Raman scattering, X-ray diffraction, and differential scanning calorimetry measurements were performed at low temperatures. The polarized Raman spectra were measured for temperatures ranging from 8 to 300 K over the spectral range of 30-3000 cm(-1). The spectral changes observed in both the lattice vibrational modes and the internal vibrational modes regions of the Raman spectrum, allowed to identify a phase transition undergone by the stearic acid crystal occurring between 210 and 170 K and a change in the structure continues to be observed down to 8 K. The anharmonicity of some vibrational modes and the possible space groups presented by the crystal at low temperatures were also discussed. Low-temperature X-ray diffraction measurements were performed from 290 to 80 K and the results showed slight changes in the lattice parameters at ∼200 K. Furthermore, the evidence of the phase transformation was provided by the differential scanning calorimetry measurements, which identified an enthalpic anomaly at about 160 K.

Events supposedly attributable to vaccination or immunization during pandemic influenza A (H1N1) vaccination campaigns in Latin America and the Caribbean.

As part of the vaccination activities against influenza A[H1N1]pdm vaccine in 2009-2010, countries in Latin American and the Caribbean (LAC) implemented surveillance of events supposedly attributable to vaccines and immunization (ESAVI). We describe the serious ESAVI reported in LAC in order to further document the safety profile of this vaccine and highlight lessons learned. We reviewed data from serious H1N1 ESAVI cases from LAC countries reported to the Pan American Health Organization/World Health Organization. We estimated serious ESAVI rates by age and target group, as well as by clinical diagnosis, and completed descriptive analyses of final outcomes and classifications given in country. A total of 1000 serious ESAVI were reported by 18 of the 29 LAC countries that vaccinated against A[H1N1]pdm. The overall reporting rate in LAC was 6.91 serious ESAVI per million doses, with country reporting rates ranging from 0.77 to 64.68 per million doses. Rates were higher among pregnant women (16.25 per million doses) when compared to health care workers (13.54 per million doses) and individuals with chronic disease (4.03 per million doses). The top three most frequent diagnoses were febrile seizures (12.0%), Guillain-Barré Syndrome (10.5%) and acute pneumonia (8.0%). Almost half (49.1%) of the serious ESAVI were reported among children aged <18 years of age; within this group, the highest proportion of cases was reported among those aged <2 years (53.1%). Of all serious ESAVI reported, 37.8% were classified as coincidental, 35.3% as related to vaccine components, 26.4% as non-conclusive and 0.5% as a programmatic error. This regional overview of A[H1N1]pdm vaccine safety data in LAC estimated the rate of serious ESAVI at lower levels than other studies. However, the ESAVI diagnosis distribution is comparable to the published literature. Lessons learned can be applied in the response to future pandemics.

Inactivation of adenosine A2A receptor impairs long term potentiation in the accumbens nucleus without altering basal synaptic transmission.

The nucleus accumbens is considered to be critically involved in the control of complex motivated behaviors. By modulating its glutamatergic excitatory input, mesolimbic dopaminergic afferents have been implicated in the reinforcing properties of drugs of abuse. However, they might not represent the only path for influencing the accumbens output. The aim of this study was to investigate possible modulation of synaptic transmission at this glutamatergic synapse by adenosine receptors. The standard field potential recording technique was used on brain slices from wild-type and A2A receptor-deficient mice. Neither the stimulus-response relationship nor paired-pulse facilitation was altered in the mutant mice. In both genotypes, the activation of A1 receptors by 2-chloro-N6-cyclopentyladenosine reduced the field excitatory postsynaptic potential (fEPSP) slope to a similar extent. In wild-type slices, activation or blockade of A2A receptors by 2-[4-(carboxyethyl)phenylethylamino]-5'-N-ethylcarboxamidoadenosine and 4-(2-[7-amino-2-(2-furyl)[1,2,4]-triazolo-[2,3-a][1,3,5]triazin-5-ylamino]ethyl)phenol, respectively, did not modify the synaptic transmission. Moreover, a long lasting pre-activation of these A2A receptors did not influence the A1 receptor-mediated reduction in fEPSP slope. Long term potentiation (LTP) of the alpha-amino-3-hydroxy-5-methyl-4-isoxazole proprionate (AMPA) receptor-mediated synaptic transmission could be elicited in both wild-type and A2A receptor-deficient mice. However, LTP appeared to be quantitatively modulated by the A2A receptor pathway since the level of potentiation was reduced in A2A receptor-deficient mice as well as in slices of wild-type mice in which the A2A receptor pathway was blocked. The involvement of the cAMP-dependent protein kinase was supported by the reduction in potentiation level in slices of wild-type mice treated with adenosine 3',5'-cyclic monophosphorothiotate, 8-(4-chlorophenylthio)-Rp isomer, an inhibitor of this enzyme. These data provide evidence that the adenosine acting at the A2A receptor is implicated in events directly or indirectly related to LTP induction in the accumbens whereas it is not involved in the regulation of the basal AMPA receptor-mediated excitatory synaptic transmission.

Human humoral immune responses against Trichinella spiralis.

The analysis of trichinellosis patients' sera was performed by Western blot against a crude extract of Trichinella spiralis. Eight distinctive bands from 38 to 104 kDa were present in most of the patients' sera as a striking homogeneous response. Some of these characteristic bands were found to be recognized by the serum of infected rodents and of an immunized rabbit in this work, and have also been reported to be recognized by monoclonal and polyclonal antibodies from T. spiralis infected or immunized rats, mice, swine or rabbits. Our data indicate that different animal species as well as humans recognize unique immunodominant epitopes of T. spiralis.

Antidepressant-like effects of pregnancy and progesterone in Wistar rats as measured in the differential reinforcement of the low-rate 72 s task.

RATIONALE: In rats, several behavioral changes occurring during pregnancy could be due to the presence of progesterone; some of them may be analyzed in the differential reinforcement of the low-rate 72 s task (DRL-72 s), which is designed for testing the antidepressant profile of drugs. OBJECTIVES: The aim of the present study was to analyze the behavior of pregnant rats or ovariectomized rats receiving exogenous progesterone in the DRL-72 s task. HYPOTHESIS: During pregnancy, rats will obtain a high number of reinforcers in the DRL-72 s task. METHODS: Pregnant rats or rats after delivery were tested in the DRL-72 s task at the 3rd, 7th, 14th, 17th, and 20th days. Control rats previously trained in the DRL-72 s task were ovariectomized; after recuperation, they received saline (0.9%, i.p.), clomipramine (1.25 mg/kg, i.p.), or desipramine (2.14 mg/kg, i.p.) for 28 days, and they were tested in the DRL-72 s task. In a second series of experiments, ovariectomized rats received vehicle or progesterone (0.5, 1.0, 2.0, 4.0 mg/kg, s.c.), and they were submitted to the DRL-72 s task. Locomotion was evaluated in the open field test. RESULTS: Pregnant rats tested at the 14th and 17th day and ovariectomized rats receiving progesterone or two tricyclic antidepressants obtained a higher number of reinforcers and a cohesive rightward shift in inter-response time distributions than those rats evaluated after delivery in the DRL-72 s task. A lower locomotion was observed only at the end of pregnancy. CONCLUSIONS: Antidepressant-like effects of pregnancy and progesterone were found in Wistar rats as measured in the DRL-72 s task.

Long photoperiod regimen may produce antidepressant actions in the male rat.

The exposure to bright light reverts the depressive symptoms of seasonally affective disorder. Rats received tricyclic antidepressants or were submitted to two photoperiod regimens. After treatments, the rats were forced to swim or were submitted to the differential reinforcement of the low-rate 72s schedule. Two animal models designed to testing the antidepressant effects of drugs. Clomipramine, desipramine or the long photoperiod decreased immobility in rats forced to swim. In the differential reinforcement of the low-rate 72s schedule, clomipramine, desipramine or the long photoperiod increased the reinforcers obtained by the rats. It is concluded that the long photoperiod regimen may produce antidepressant effects in male Wistar rats.

Isolation rearing induced fear-like behavior without affecting learning abilities of Wistar rats.

1. Isolation-reared rats display fear-like behavior and depressive-like behavior in several behavioral tasks, suggesting that isolation rearing may model certain aspects of human psychopathologies. 2. After weaning (20 days old), male and female Wistar rats were isolation-reared during 20, 50 or 70 days. After that, they were tested in the elevated plus maze test, and in the open field test. Another group of isolation-reared rats (70 days of isolation) were tested in an auto-shaping task. 3. Isolation-reared rats displayed high levels of fear-like behavior in the elevated plus-maze test, and hyperlocomotion in the open field test. But, isolation-reared rats learned an auto-shaping task. 4. In conclusion, isolation rearing induced fear-like behavior, without affect learning abilities of rats.

A case-control study on complications and survival in elderly patients undergoing major head and neck surgery.

BACKGROUND: Several studies in the literature have shown that older patients have a poor prognosis after the treatment of cancer. They are frequently considered to have a high surgical risk and undergo substandard treatment. PATIENTS AND METHODS: This case-control study analyzes complications, mortality, and survival in 115 patients 70 years of age or older and 115 controls matched by site and clinical stage. Most tumors were located at the oral cavity, salivary glands, pharynx, or larynx. RESULTS: The frequency of postoperative complications, mortality, and recurrences were similar in both groups. Twenty elderly patients and 9 controls died due to causes not related to cancer. The 5-year survival rates were 43% for the elderly patients and 55.6% for the control patients (P = 0.1038). CONCLUSION: The main causes of death in the elderly patients were not related to cancer or treatment complications. This emphasizes the need for the use of standard treatment for all patients who remain in good medical status.

Parasitism among polychaetes: a rare case illustrated by a new species: Labrorostratus zaragozensis, n. sp. (Oenonidae) found in the Gulf of California, Mexico.

We describe a new species of polychaetous annelid from the family Oenonidae, Labrorostratus zaragozensis, n. sp., which is parasitic on another polychaete from the family Trichobranchidae (Terebellides californica). It can be differentiated from the other 4 species of the genus (Labrorostratus parasiticus, Labrorostratus jonicus, Labrorostratus prolificus, Labrorostratus sp.), basically by the shape of the mandibles and in the case of L. luteus, by the presence of hooded acicular hooks. Along with the description, a review and discussion of all previous records of the parasites in the Oenonidae and their related interactions with their hosts is presented.

Sodium requirements, balance and tissue composition of growing pigs.

The sodium requirements, balance, excretion, patterns and composition of some pig tissues were studied in two feeding trials and a balance trial followed by an additional feeding period with terminal tissue composition analysis. The growth of pigs fed a corn-soybean meal diet without added salt was severely restricted. Results confirm that a sodium requirement of .09% of the diet is adequate and that .20% NaCl supplementation is adequate for any natural diet for swine. Diets containing .065% sodium caused about a 25% reduction in growth when fed to 10-kg pigs but no significant reduction when fed to 27-kg pigs. Dietary retention was 96% for pigs fed .032% or .067% sodium. Retention was less per unit gain (gain was greater per unit sodium retention) fo9r pigs fed .032% sodium than for pigs fed .067% or more sodium. Those fed .032% sodium had a greater PCV after 1 week on trial and a smaller plasma sodium concentration after 2 weeks. The terminal tissue analyses showed that the pigs fed the lowest sodium diet had lower concentrations of sodium in plasma, muscle and bone, lower concentrations of chloride in plasma and muscle and a greater plasma potassium concentration. Crystal sodium of bone was not significantly affected.

Percutaneous treatment of acute soft tissue lesions with naproxen gel and ketoprofen gel.

A randomized independent-group, single-blind study was performed to compare the analgesic efficacy and the local and cosmetic tolerability of 3-5 cm of 10% naproxen gel with 10% ketoprofen gel in 30 patients complaining of moderate or severe pain due to acute soft tissue lesions. Both drugs were administered topically and were applied to the painful area at least once every 12 h as required. Naproxen gel was effective, cosmetically acceptable and safe in the treatment of acute soft tissue lesions. Efficacy and tolerability of both naproxen gel and ketoprofen gel were comparable, although naproxen gel produced a significantly greater reduction in pain on deep palpation by the third day of treatment.